Letter from the Chair – ACEP Tactical Emergency Medicine Section

Hello, I sincerely hope that this letter finds you and yours safe and warm and healthy.  Fortunately, the days are getting longer, with a nice warming trend throughout our country. Less than 2 weeks ago as I drove to work in the ED it was -7 degrees F on my car temperature gauge.  A little bit cold, one might say.  Others in the country had it even colder.

Challenges exist each day for each of us. Some are more difficult than others. In Texas, millions of good people suffered from extreme cold and loss of power, frozen pipes, and freezers and refrigerators failed to work without electricity, resulting in tons of spoiled food.  To top that off, many grocery food stores rapidly emptied, with citizens having to rely on canned foods from the basement and other places. Those who prepared and had generators and fuel and extra food were better off, and those who were less prepared learned some valuable lessons. We send our prayers and best wishes to all for a full recovery.

Last night, as I finished my ED shift in the COVID POD of our emergency room from 3 pm to 11:30 pm,

I walked to my car, noting the air temperature was in the lower 50s, much better than – 7 F. 

Earlier in the shift, an unfortunate drug-violence related shooting had occurred with a young male shot in the left eye and the bullet caused extensive brain damage, and he was seen by the trauma team and intubated expertly by a female 2^nd year EM resident, and admitted to the Neuro ICU, with low expectations of survival. Perhaps a donor, perhaps others may benefit from a tragic situation.  Now, 8 hours later, police had identified a relative’s house nearby and after establishing a perimeter / contained the house, and a “knock and talk” with the house owner, it was quietly revealed that the shooter / attempted murder suspect was actually inside the house.

So, I found out about the recent discovery while driving less than a mile on the way home when my phone text notified me of our city’s police SWAT team deployment.  The text described the location, safe route, and a meeting location in the parking lot of a church several blocks away from the house with the suspect.  Within 8 minutes I was there, and soon most of the SRT / tactical team had arrived, donned our gear, and deployed. TacMed communications occurred, we assembled a team of 4, including 1 attending EM physician, one resident EM physician, and 2 tactical paramedic firefighters, all dressed for success with ballistic protective gear and TacMed equipment. 

Negotiators used bullhorn speakers to seek surrender, but it didn’t happen. No motion from the house. The BearCat armored vehicle was brought to the scene and continued attempts to talk the suspect into surrendering and walking out.  After extensive efforts and a 2-hour delay getting a search warrant, the remote-controlled robot was used to carefully search the upper floors, but multiple debris and paint cans prevented the robot from going downstairs into the basement.  Next, a cautious and slow and deliberate search, with myself, an EM resident, and a firefighter paramedic 20 feet away from the house, inside the BearCat armored vehicle on stand-by in case any gunfire erupted. It rained from 03:30 to 05:00, and ponchos and other rain gear was effectively utilized by our LEOs.  Mirrors, pole cameras, and plenty of slow caution. House was cleared, except for the basement, to be searched last.  Soon, with over 10 tactical officers slowly searching with shields and high-tech equipment, the last room of the basement needed to be cleared.  With extreme caution, the tactical officers utilized their extensive training and tools and tactics, to search the very last corner.  There, hiding behind a box and an old plastic Christmas tree, was the suspect.  Fortunately, no gunfire erupted, and the suspect was quietly taken into custody. 

We were Blessed, and the team went home after debriefing.  Mission success.  We each quietly reflected on things while driving home, I imagine.  Pondering ‘what if’ it had turned out violently.  What if a doorbell camera system had allowed the suspect to see the approaching team and blindly fire rifle bullets through the front door as had occurred just a few weeks ago in Sunrise, Florida, killing 2 dedicated FBI agents, wounding 3 other officers, and shattering multiple family’s lives.  Tonight, for our team, we were perhaps luckier, and Blessed, with the absence of violence.  When it is the criminal who ultimately decides how the ending will be, it often boils down to plain and simple luck.   Interestingly, the female EM resident (who had previously completed our tactical medicine training elective this past year) was the same resident who intubated the unfortunate GSW victim in the trauma bay less than 10 hours earlier, and she was there now supporting our brave women and men in Blue.   Call it preventive medicine, perhaps.  Helping to remove another criminal off the streets, with a direct result of preventing further violence and death. Mission success.

Other News

Positive recent national news includes the successful deployment of COVID vaccines, and we are achieving additional steps towards the goal of reaching ‘herd immunity’, which is an achievable goal throughout the world.  As we gradually return towards normal, pre-COVID 19 lives, hopefully we will return to familiar routines and habits.  However, many people have chosen to not get the vaccine, and reasons are varied for this.  Each of us section members can do our part to be an example, and we can also help educate our fellow pre-hospital first responders, including law enforcement, EMS, and Fire Department brothers and sisters.  Many have distrust in the new production methods of mRNA vaccines, and we need to emphasize the many benefits certainly outweigh the very minor risks and side effects. 

The TEM Section website continues to develop, and ACEP recently announced that there will be a new format that soon will be utilized throughout all section web sites.  We are still looking for educational and other content to be added by you and other section members to add to our Tactical Emergency Medicine Section website.  If you have any photographs or case reports to share, or any educational video clips or educational prior point lectures or TTPs / protocols that you would like to share with other members, then please submit these as specified on the website, thanks.

The March 2021 quarterly TEM Section newsletter has a variety of good articles and information that will hopefully benefit you and other members.  There is a lot going on currently, and we have a number of areas of focus, and one of these includes a tactical medicine survey that was sent out to multiple nation-wide law enforcement administrators, which was arranged by Dr. Keegan Bradley working with Dr. David McArdle.  The survey has a goal of clarifying the importance and involvement of tactical medicine within law enforcement agencies and current views and actual use.  The results are pending we will keep the membership appraised as results are collected.  In addition, we have several specific programs and projects being developed by Chair-elect Dr. Brian Springer, Dr. Keegan Bradley, and Dr. Dominique Wong, myself, and others.  This quarter’s newsletter has several interesting articles, including original publications, several references and important topics, a tactical team call out review, and other information which will hopefully be educational and worthwhile.

I encourage each of you to continue to pursue education and training in tactical medicine, and to explore your options in your own region to support law enforcement officers and agencies to your heart’s desire.  Each of us has our own unique situations and opportunities and limitations.  Seek out advice, explore your training and education options, take time to read, and now that the pandemic barriers will be going away slowly, perhaps you may be able to take time to travel to a new part of the country to seek experience and training opportunities to enhance and build on your foundation.  Many of us have found tremendous rewards in working with our local agencies and law enforcement officers to help our communities be safer for our families and children.  Let us continue to work together to identify and overcome barriers, and to share knowledge and useful information in the hope that we can do it even better and with more success tomorrow.  Those of you who are new to this exciting subspecialty, we welcome you, it will be an honor to serve together, and we are happy to assist.

With highest regards and warmest wishes,

Thank you,

E. John Wipfler, III, MD, FACEP